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Impact of a physician-supervised exercise-nutrition program with testosterone substitution in partial androgen-deficient middle-aged obese men

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Journal of Geriatric Cardiology 2011年第4期8卷 201-206页

作者： ernst r schwarz robert D Willix Jr Cenegenics Education and research Foundation Las Vegas and Heart Institute of Southern CaliforniaBeverly Hills348 S Oakhurst DrBeverly HillsCA 90212USA

Background Partial androgen deficiency syndrome in the aging male is associated with signs of aging such as a development of abdominal obesity,sexual dysfunction,increase body fat,weight gain and the development of cardiac *** We assessed the outcome of a commercially available physician supervised nutrition and exercise program with concomitant testosterone replacement therapy in middle age obese men with partial androgen deficiency in order to reduce cardiac risks *** Fifty-six self referred men without diabetes mellitus,hypertension,or cardiovascular disease(ages 52.3±7.8 years)were randomly selected from a large *** weight,body fat composition,fasting glucose,hemoglobin A1c and fasting lipid levels,as well as free and total testosterone levels were *** patients were assessed and followed 6–18 months after initiation of the *** program consisted of a low glycemic load balanced nutrition diet,a recommended structured daily exercise program of 30–60 minutes,as well as once to twice weekly intramuscular testosterone injections(113.0±27.8 mg).results At follow up,weight was reduced from 233.9±30.0 pounds(lbs)to 221.3±25.1 lbs(Preduced from 33.2±3.3 kg/m2 to 31.3±2.8 kg/m^(2)(Preduced from 95.3±14.4 mg/dL to 87.5±12.6 mg/dL(Prol was reduced from 195.4±33.0 mg/dL to 172.7±35.0 mg/dL(Prse events were *** Testosterone replacement therapy in middle aged obese men with partial androgen deficiency appeared safe and might have promoted the effects of a weight reduction diet and daily exercise program as long as an adequate physician supervision and follow up was *** combination therapy significantly reduced coronary risk factors such as glucose intolerance and hyperlipidemia.

关键词： aging heart disease androgen deficiency testosterone

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Heart failure in the elderly-some aspects in pathophysiology,diagnosis and therapy that require special attention

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Journal of Geriatric Cardiology 2007年第1期4卷 44-49页

作者： ernst r. schwarz Division of Cardiology and Comprehensive Transplant Center Department of Medicine Cedars Sinai Medical Center & University of California Los Angeles (UCLA) Los Angeles California USA

Approximately 50% of all heart failure patients in the US are above 75 years of age, which is almost similar to most European countries and the Middle and the Far East. Even though aging is an independent molecular process with a multitude of genetic predetermination and biochemical mediations, aging itself does not automatically result in cardiac insufficiency. On the other hand, with increasing age, cardioprotective mechanisms in response to stress are lost, and progressive cardiomyocyte degeneration with replace- ment fibrosis is often seen in older hearts, even though the exact triggers are not completely understood. Older patients with heart failure have distinct features that require special attention in diagnosis as well as therapy. The elderly more frequently suffer from multiple co-morbidities and might have atypical clinical presentations. Several precautions are essential in the treatment of heart failure in the elderly due to co-existing morbidities and the pharmacokinetic and pharmacodynamic changes related to increased age. Also, treatment expectations, compliance, mental status and cognitive function might play a major role regarding optimized treatment and monitoring options in the elderly suffering from heart failure. This review summarizes current issues of heart failure management in the elderly.

关键词： heart failure aging left ventricular function mortality elderly

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Left and right ventricular diastolic dysfunction and diastolic heart failure: does one lead to the other?

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Journal of Geriatric Cardiology 2009年第1期6卷 3-10页

作者： Faramarz Tehrani Anita Phan ernst r. schwarz Division of Cardiology Department of Medicine Cedars-Sinai Medical Center and University of California Los Angeles Los Angeles California Division of Cardiology Department of Medicine Cedars-Sinai Medical Center and University of California Los Angeles Los Angeles California Division of Cardiology Department of Medicine Cedars-Sinai Medical Center and University of California Los Angeles Los Angeles California

Background and Objective Diastolic dysfunction of the left ventricle is a mechanical abnormality diagnosed primarily by echocardiogram, and can be distinguished into three separate degrees based on the severity of reduction in passive compliance and active myocardial relaxation. Methods A literature search was performed for basic science studies, clinical studies and major practice guidelines on the subject of diastolic dysfunction and diastolic heart failure. Important findings were analyzed and correlated with regard to clinical relevance. results Left ventricular diastolic dysfunction appears to compromise exercise tolerance and is believed to contribute to the pathophysiology in patients with diastolic heart failure. In the clinical setting, however, oftentimes no clear distinction is made between echocardiographically diagnosed diastolic dysfunction and diastolic heart failure, and adequate treatment recommendations are sparse and aimed to prevent worsening and progression of clinical symptoms. To date, there is a lack of high powered trials assessing the possible progression rate from echocardiographically diagnosed diastolic dysfunction to the clinical diagnosis of diastolic heart failure. Furthermore, there are no solid indices to assess the degree of severity of diastolic dysfunction or its progression. Pure right ventricular diastolic dysfunction appears to be even less understood and under-recognized, although it may play a role in the development of both right and left heart failure. Currently there are few but interesting data on the possible interaction between ventricles with diastolic dysfunction and the overall affect on the development of heart failure. Conclusions The timeline and progression of diastolic dysfunction to diastolic heart failure have not been well established and warrant further investigation.

关键词： Diastolic dysfunction diastolic heart failure left ventricular dysfunction heart failure cardiomyopathy

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Heart failure in very elderly population-a profile of heart failure in patients over the age of eighty

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Journal of Geriatric Cardiology 2007年第1期4卷 20-24页

作者： Christopher V. Chien Dani Hackner ernst r. schwarz Division of Cardiology and Comprehensive Transplant Center Department of Medicine Cedars Sinai Medical Center & University of California Los Angeles (UCLA) Los Angeles California USA

Objective Heart failure is an epidemic in the elderly, but there is a striking lack of data in this clinically important patient population. We investigated the demographics, cardiac performance, and medication management of a segment of the hospital popula- tion in at least their eighth decade of life. Methods We retrospectively reviewed 75 records of heart failure patients who were 80 years of age or older. records were reviewed for demographic information, presence or absence of diastolic dysfunction, evaluation of ejection fraction, and medication usage including angiotensin-concerting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ArBs), beta-adrenergic blockers, digoxin, and aldosterone antagonists. Assessment for contra-indications to ACE inhibitor or ArBs use was also performed to assess co-morbidities that limit treatment of heart failure. results The population of very elderly with heart failure is heterogeneous. We found a higher proportion of females as well as higher rates of diastolic dysfunction in patients aged ≥ 90 years compared to patients between the ages of 80-89 years. Usage of ACE inhibitors, ArBs and beta-adrenergic blockers was strikingly low throughout the very elderly population. While co-morbid conditions limited use of agents in many cases, there was a lack of explicit contra-indication in most patients not on an ACE inhibitor or an ArB. Conclusions Heart failure is not a single disease processes, but a continuum of disease processes that vary with age. The elderly with heart failure are an undertreated population, in part due to the multitude of co-morbidities that affect them. Further prospective studies are needed to better understand the physiology and ideal treatment regiment in this growing population.

关键词： heart failure elderly octogenarians nonagenarians centenarians

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Predictors of re-hospitalization in patients with chronic heart failure

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World Journal of Cardiology 2012年第2期4卷 23-30页

作者： Melody Zaya Anita Phan ernst r schwarz Cedars-Sinai Heart Institute Cedars-Sinai Medical Center

Heart failure (HF) is a chronic, progressive illness that is highly prevalent in the United States and worldwide. This morbid illness carries a very poor prognosis, and leads to frequent hospitalizations. repeat hospitalization in HF is both largely burdensome to the patient and the healthcare system, as it is one of the most costly medical diagnoses among Medicare recipients. For years, investigators have strived to determine methods to reduce hospitalization rates of HF patients. Despite such efforts, recent reports indicate that rehospitalization rates remain persistently high, without any improvement over the past several years and thus, this topic clearly needs aggressive attention. We performed a key-word search of the literature for relevant citations. Published articles, limited to English abstracts indexed primarily in the PubMed database through the year 2011, were reviewed. This article discusses various clinical parameters, serum biomarkers, hemodynamic parameters, and psychosocial factors that have been reviewed in the literature as predictors of re-hospitalization of HF patients. With this information, ourhope is that the future holds better risk-stratification models that will allow providers to identify high-risk patients, and better customize effective interventions according to the needs of each individual HF patient.

关键词： Heart failure readmission Predictors rehospitalization Chronic heart failure Hospitalization

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Evaluation of the prevalence and severity of pain in patients with stable chronic heart failure

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World Journal of Cardiology 2012年第8期4卷 250-255页

作者： Dioma U Udeoji Ankit B Shah Parag Bharadwaj Peter Katsiyianis ernst r schwarz Heart Institute of Southern California TemeculaCA 92592United State Cedars-Sinai Medical Center Los AngelesCA 90048United States University of California Los Angeles Los AngelesCA 90095United States Heart Institute of Southern California TemeculaCA 92592United State Dioma U Udeoji

AIM: To evaluate the prevalence and severity of pain in patients with chronic stable heart failure (HF) in an outpatient clinic setting. METHODS: This is a cross-sectional study evaluating symptoms of generalized or specific pain in patients with chronic stable heart failure. A standardized questionnaire (Edmonton Symptom Assessment System) was administered during a routine outpatient clinic visit. The severity of pain and other symptoms were assessed on a 10 point scale with 10 being the worst and 0 representing no symptoms. rESULTS: Sixty-two patients [age 56 ± 13 years, 51 males, 11 females, mean ejection fraction (EF) 33% ± 17%] completed the assessment. Thirty-two patients (52%) reported any pain of various character and location such as chest, back, abdomen or the extremities, with a mean pain score of 2.5 ± 3.1. Patients with an EF less than 40% (n = 45, 73%) reported higher pain scores than patients with an EF greater than 40% (n = 17, 27%), scores were 3.1 ± 3.3 vs 1.2 ± 1.9, P requent symptoms were tiredness (in 75% of patients), decreased wellbeing (84%), shortness of breath (SOB, 76%), and drowsiness (70%). The most severe symptom was tiredness with a score of 4.0 ± 2.8, followed by decreased wellbeing (3.7 ± 2.7), SOB (3.6 ± 2.8), and drowsiness (2.8 ± 2.8). CONCLUSION: Pain appears to be prevalent and significantly affects quality of life in HF patients. Adequate pain assessment and management should be an integral part of chronic heart failure management.

关键词： Heart failure Pain Symptoms Therapy Palliative care

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